Medicine with a great future

All professions are important, and of course, all of them are needed and necessary. However, if we ask people in our country, in which profession the quality of education is most important, I think the majority will answer - the doctor. And they will be right because those who at least once was hospitalized clearly realize that in the hands of people in white medicine gowns there is the most important value – human life.

Time does not stand still, and medical approaches to the treatment of various diseases are also being upgraded and modernized from year to year. And the main task of the Educational Clinical Center “Astana”, established by the Capital Akimat (Municipality) 10 years ago, is just training and a steady improvement of professionalism of doctors. About that from whom Center is borrowing invaluable experience and what directions of local medicine are still in need of substantial progress, to the correspondent of El.kz was told by the chairman of the Supervisory Board of Educational Clinical Center “Astana” Karshigha Kulmukanov.

- Karshigha Kakeshevich, Educational Clinical Center “Astana” this time turns to 10 years. What has changed cardinally over the past decade?

- Of course, such a time interval historically is rather short. However, during this time, the newly created by the Akim (Mayor) of the city of Astana Mamin Askar Uzakbayevich, the Center has successfully passed not only the stages of its formation but also managed to do many necessary and useful tasks and affairs in the field of additional education for healthcare professionals of the developing Capital of our Country.

At the beginning of the activity, the main efforts were directed towards the creation on the basis of the Educational Clinical Center of the first not only in Astana city but also in the country simulation educational center training according to the international standards. This has became possible due to the close cooperation of the Akimat (Municipality) of Astana city with the Medical Corporation "Partners HealthCare System" (Boston city, USA), which is actually the Clinical Base of the Harvard Medical School, through to which for the first time on the basis of the Center produced the technology transfer of simulation technologies was carried out according to the programs of the American Heart Association (AHA).(Originally this non-profit organization of American Cardiologists was found in New York City in 1924 but currently headquartered in Dallas City, Texas). This was a fundamentally and essentially new structure for the Capital's healthcare, the main task of which was the introduction and implementation of simulation training technologies in Kazakhstan.

For 10 years of its work the organization has shown and demonstrated excellent results, and all this was achieved thanks to hard work and continuous improvement of the knowledge and skills of the staff of the Center. Doctors-instructors of the Educational Clinical Center "Astana" underwent and have passed special training in the simulation centers of the USA, Israel, Italy, Singapore and other countries, almost all of the crew of the Center have international certificates. Also, recognized foreign experts were invited to Astana City, who conducted and held master classes for the doctors of the city on the spot inside the special places of the Center, and now on the basis of our Center for the several years, successfully conducted courses on emergency medical service and care in accordance with international standards.

- 10 years - isn’t short period. What exactly has been able to achieve and reach the organization during this time?

- Within the framework of the external evaluation of the performance indicators of Educational Clinical Center “Astana” on the basis of data of the National Statistical Ranking of the Countrywide Republican Rating Program for awarding enterprises-leaders of the economy of Kazakhstan - The Center five years in a row becomes the owner of the elite sign of honor “Leader of the branch” (2013-2017), and in 2016 it became the owner of the sign “Pride of Education”. In 2014 the Educational Clinical Center “Astana” underwent and passed the State certification of the Ministry of Health of the Republic of Kazakhstan, once again proving the effectiveness of its work, and our specialists of the Center repeatedly received diplomas of appreciation and Thank-you letters from the Ministry of Health of the Republic of Kazakhstan, the Akimat (Municipality) of Astana City and the capital city branch of the Party "Nur Otan".

To date, the Educational Clinical Center is an equal and full member of the Pan Asia Simulation Society in Healthcare (PASSH), the Group of International Simulation Pediatric (GISP), the Society of European Simulation Application in Medicine (SESAM) and the Russian Simulation Education in Medicine (RSEM), thereby improving the high level of the quality of simulation training, recognized as one of the advanced methods of training medical personnel. Of course, this is the result of a constant search for new ways in the work and continuous improvement of the learning process of the whole structure of the collective and the entire team. Educational Clinical Center “Astana” always considers it its Patriotic duty to actively participate in special training in accordance with international standards in teaching the knowledge and skills of both staff and participants in the preparation and conduct of important large-scale events for our country as the OSCE Summit held in Astana in 2010, VII Winter Asian games held in Almaty and Astana in 2011, The Winter Universiade  held in Almaty in 2017,  International Exposition EXPO 2017 held in Astana, teaching personnel  staff, volunteers, as well as medical and health professional workers the skills of providing emergency assistance in accordance with international standards.

- As far as we know, the Center is actively trying to introduce and embed foreign experience into national medical practice. Skills, knowledge, and experience of which countries have recently been most actively adopted by our doctors?

- We aren't trying to learn from the experience or adopt knowledge of any particular country but work on international standards according to evidence-based medicine. The Educational Clinical Center “Astana” cooperates effectively with the leading universities of the United States of America, State of Israel, Republic of Korea (South Korea), Federal Republic of Germany, Republic of Lithuania, State of Japan, Russian Federation and many others. Our Center actively participates in the implementation and realization of programs of maternity (motherhood) and childhood protection, modernization of the ambulance service and other priority directions in the development of healthcare of the Republic of Kazakhstan. Memorandums on cooperation on the issues of professional development of medical workers and the exchange of experience with eminent foreign clinics and centers have been concluded and signed. Foreign specialists and experts conduct, provide and carry out training for employees of our Capital clinics, the staff of hospitals at workplaces where more than 3,000 health care workers of the Capital have been trained. We have organized more than 150 master classes and training workshops with the involvement and participation of foreign specialists conducted more than 220 demonstration processes and exhibition operations.  Today our specialists and experts can already compete with foreign colleagues in terms of their knowledge and skills.  City medical organizations today provide a sufficiently large volume of highly specialized medical care, which previously turned out to be clinics of national importance. All this became possible in large part due to the training of more than 500 of our specialists at internships and master classes in the best foreign clinics. This is a high figure, which certainly pleases us.

- Which professional structures in medicine still need a serious increase in the level of qualifications, and which, in principle, are not far behind the level of the leading countries?

- On this occasion, of course, I will express my personal opinion. Despite the great positive changes in the industry, which largely relate to the development of the network of medical organizations, infrastructure changes, the equipment of hospitals and polyclinics, as well as to take into account the achievements of medicine in such types of care as cardiosurgical, neurosurgical, orthopedic and traumatological, which is far stepped forward, then the level of professional competence in the rest of many relevant specialties to meet advanced international standards is still not noticeable . This must be recognized, and in this regard, it is necessary to work especially with specialists working on such kinds of medical assistance as - pediatric and obstetrical-gynecological care. In these areas, the health authorities and various organizations engaged in post-graduate education are making a priority effort.

- There is a logical question arises: what is the indicator for determining the level of the professional area?

- One of the main indicators is the satisfaction of patients, where there are fewer complaints and complaints from their side. Another, even more important, is the reduction in mortality, morbidity, and disability. These indicators have been and will be relevant at all times. For example, if earlier there were very many deaths from cardiovascular diseases, then with the opening of a cardiosurgical center, which in fact became the locomotive of this type of care, and other cardiac centers in the regions of the country, the death rate from myocardial infarction, from angina pectoris significantly decreased. This means an improvement in the survival rate. What cannot yet be said about oncology - too, like a great effort, but there progress is slower, there are neglected cases, so the death rate from cancer decreases not as fast as we would like.

There is a significant increase in positive dynamics in maternal and infant mortality, but we have not yet reached the indicators of the OECD countries. But there is still a systematic decrease in mortality. That's why we invite experts from the leading countries in the field of medical innovations. Previously, we often sent domestic specialists to study abroad, but recently we are more practicing the arrival of leading foreign specialists to us so that as many people as possible get an important experience. Coming here, they conduct master classes and direct operations. The effect of this format is much larger, and therefore it is considered more prestigious.

- Who in most cases finances the training of doctors?

- Within the framework of creation of competitive personnel potential of city health care, through the improvement of professional medical training and upgrading of domestic health personnel within the country, abroad and with the involvement of leading foreign specialists (transfer of technologies), and development of the potential for international cooperation in medicine, on the training of doctors, according to the approved annual plan. In this way, most of the budgetary appropriations. In turn, medical organizations of the city, as necessary, send doctors to upgrade their skills on especially topical issues, based on their approved annual plan or by saving money. In addition, doctors can, at their own expense, undergo training in practical skills necessary for obtaining a qualification category or its confirmation, as well as training in international standards, since the availability of a certificate of such training is a prerequisite for employment in some medical institutions.

- Tell us about the work of the Center. What contingent do you usually learn?

- The work of the Center is closely integrated with the work of practical health care, educational programs are constantly being improved, new cycles are being developed taking into account the current directions of the health system and the needs of the medical organizations of the city. Today, within the framework of the local budget program at the Astana Training and Clinical Center, refresher courses are provided for employees of city medical organizations and republican medical institutions, including the Hospitals of the Medical Center of the Presidential Affairs Department of the Republic of Kazakhstan, the National Scientific Cardiosurgery Center, the National Research Center motherhood and childhood, the Republican Children's Rehabilitation Center, etc. Today we successfully apply innovative educational services not only ko for clinicians, but also for managers and other healthcare professionals, all courses are based solely on modern technologies, their effectiveness has been proven many times.

- One of the most important and most objective indicators of the level of development of medicine is the provision of emergency care. How is work to improve the emergency medical service?

- In recent years, certain measures have been taken to improve and modernize the ambulance service to improve the timeliness and availability of NSR services, and target indicators for assessing the activities of the NSR service across all regions of the country are being introduced. Along with the constant training of specialists of the NSR with the skills of emergency care, the Training and Clinical Center "Astana" has been the initiator and organizer of the annual Republican competitions of ambulance teams for two years in a row, with specialists from all regions of Kazakhstan taking part. For the first time this event was held in June 2016 in Almaty, and in May 2017 in Astana in preparation for the international specialized exhibition "EXPO-2017", the Second Republican competitions of ambulance teams were held.

The high assessment of the organization was given by the Minister of Health of the Republic of Kazakhstan Elzhan Birtanov, noted the urgency and importance of the work of emergency specialists in providing medical assistance to the population of the country and proposed holding such competitions annually. In general, the idea to hold competitions for ambulance teams in our country arose from the experience of Lithuania, where such competitions of international level have been held for 10 years already. "Astana" ECC has prepared several ambulance teams from Astana and Almaty to participate in international competitions in Lithuania. Our teams are worthy of performing and taking prizes. For example, this year the brigade from Almaty took the honorable first place.

- What is the role of the Supervisory Board and the mechanism of its interaction with the ECC?

- Supervisory councils are one of the forms of the institution of corporate governance, which contributes to increasing the efficiency of the organization's activities, transparency of all its activities. From the first days of its work, the Educational Clinical Center "Astana" has a Supervisory Board. The Council monitors and controls the activities of economic and financial activities of LLP ‘ECC” while contributing to the management process in the form of proposals for strategic development and in the course of its current activities. The structure of the Supervisory Board included respectable individuals: former deputies of the Parliament of the Republic of Kazakhstan and the capital Maslihat, although they say that “there are no former deputies”, Rector of the University,

the head of a large medical Association, the head of the Law Company, the head of the Center for Assessing the Knowledge and Skills of Health Professionals. There is undoubtedly a merit of the Observation Center in the constant success of the development of LLP “ECC”, which for a short time has created a network of its branches in all regions of our country and can also transfer the most modern international technologies of medical care there.

- You mentioned the training of paramedics. Tell us more about this.

- As the world experience shows, it is very important to properly provide the necessary first aid before the arrival of medical workers and thereby save lives. In addition to medical specialists, the Astana Training and Clinical Center also teaches paramedics the proper provision of pre-emergency emergency care according to international standards: drivers, employees of transport companies, emergency services, hotel services, teachers, athletes, etc. Since last year, the specialists of the Center have been training the staff of the onboard teams of the National “Air Astana”, “Qazaq Air” and “Bek Air’, the main purpose of the courses is to teach flight attendants to provide emergency assistance to passengers. More than 2,000 airline employees have successfully completed training. Specialists of JSC “Air Astana” give an excellent assessment of the quality of training and already successfully apply the knowledge gained, saving lives of passengers in emergency situations with health.

Using the accumulated experience in training the paramedics of the first emergency aid, the Center contributed to the successful holding of the international specialized exhibition EXPO-2017, the 28th World Winter Universiade-2017, VII Asian Games, training volunteers. A total of about 400 volunteers have been trained. A worthy response to the high quality of educational services and the reliability of the center in the implementation of the commitments undertaken was the recognition of the Astana Clinical Training Center as an official partner of the 28th World Winter Universiade-2017 in Almaty.

- Tell us about the training of doctors in the regions. How much are the levels developing in Astana, Almaty and other Kazakhstani regions?

- The training and clinical center does not stand still, it is constantly developing, introducing all new technologies, updating its knowledge base, keeping pace with the times. In order to expand activity in the market of additional medical education, 16 branches of the Center are open on the territory of the republic. The tasks are implemented to disseminate advanced medical knowledge and technologies introduced in Astana to regional healthcare. The practice of transferring innovative methods to regional healthcare through the training of doctors and nurses is being conducted, and master classes are being organized with the invitation of the best foreign specialists.

- At what level is now the system of training of domestic psychologists? Is it possible to say that this profession has made a significant step in the last 10 years?

- Unequivocally, we can say that the profession of a psychologist is very important today and has taken a significant step forward. In each educational institution, there is a psychologist who works with children, teenagers, youth. The "Astana" center pays special attention to the issue of organizing assistance to people with mental illness, including alcohol and drug addicts, persons prone to suicide, especially adolescence, etc. Thus, in recent years, several pieces of training have been conducted on the basis of the MCHP and the Center for Narcology and psychotherapy in Astana with the participation of leading experts from the Russian Federation on psychotherapy and psycho-correction in crisis situations, prevention of teenage suicides, assisting people with chemical and non-chemical additives etc. The training was attended by doctors, psychotherapists, drug treatment clinics, psychologists and social workers youth health centers for PHC.

- Many branches of human activity today are developing thanks to technological innovations, and medicine is no exception. Tell us about new developments in the field of medical technology.

- In order to develop the national healthcare, the State Healthcare Development Program of the Republic of Kazakhstan "Densawlyq" for 2016-2020 has been developed. Within this framework, the most relevant sections of medicine are being improved: cardiac surgery, interventional medicine, neurosurgery, maternal and child health, traumatology, oncology, etc.

The "Astana" ECC sends to the advanced clinics abroad, where our specialists are trained in new high-tech methods of diagnosis and treatment of patients.

Now these clinics are being introduced in the city's clinics, which were previously conducted only in clinics of national importance. For example, modern methods of high-flow oxygen therapy in children with respiratory failure, the use of high-frequency ventilation in young children are introduced in children's practice. There are also many new surgical techniques in oncology for bladder cancer.

Diaskintest was introduced in the TB dispensary, a modern drug for detecting latent forms of tuberculosis. In comparison with the already known and already used Mant reaction for almost 100 years, a new means of primary diagnosis makes it possible to determine infallibly whether a person is infected with tuberculosis bacteria or not. And also a new method of treatment for osteoarticular tuberculosis (revascularization of large joints) is included in the work. It should be noted that the development of such a direction as rehabilitation. This section of health plays an important role in the recovery of patients both after a stroke, cardiosurgical interventions, injuries, etc.

- I can not help but ask about the very topical topic in recent years of the Mandatory social health insurance. Until now, not all people understand its need for a domestic health care system. Share your point of view?

- “Mandatory social health insurance” guarantees equal access to medical and medicinal care for all insured citizens of Kazakhstan regardless of their sex, age, social status, place of residence and income, thus “Mandatory social health insurance” is a form of social protection of the population's interests in health protection in the event of illness, injury, pregnancy and childbirth, disability and old age. The experience of over 50 countries was considered and taken into account when deciding on the introduction of compulsory health insurance in Kazakhstan. The system of medical insurance in Kazakhstan was developed on behalf of the Head of State Nazarbayev NA, the Law “On Compulsory Social Health Insurance” was adopted in 2015. Since last year, in all regions of Kazakhstan, a large-scale action was launched to explain the basic principles of the system of compulsory social health insurance among medical workers in our Republic. The Astana Training and Clinical Center also took responsibility for explaining to the medical workers of the city of Astana the main aspects of the Law of the Republic of Kazakhstan “On Compulsory Social Health Insurance”. So, for the period from November 2016 to May 2017, the Center held seminars, attended by more than 2500 health workers. The specialists of the Center tried to explain in more detail the OSMS system, the goals, and benefits of the “Mandatory social health insurance”, explain the size of the rates and the procedure for payment in the system of compulsory social health insurance, and etc..

- Thank you for the interview!

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